USAID brief on hormonal contraception: While questions remain, women at high risk and with HIV can use all available methods

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While evidence of a tie between some injectable hormonal contraceptives and an increased risk of HIV acquisition remains incomplete, that potential risk must be balanced against the life-saving benefits of preventing unintended pregnancy, a brief from USAID’s Office of Population and Reproductive Health says.

The brief, prepared in collaboration with the U.S. President’s Emergency Plan For AIDS Relief notes that several follow-up analyses by researchers of their earlier findings suggesting injectable contraception could double the risk of HIV acquisition supported the findings. Another analysis did not suggest a significant association between HIV acquisition and oral or injectable contraceptives, but with a caveat —  the authors noted uncertainty on injectable contraception effects and HIV risk. At the same time, the brief points to modeling studies that have concurred that unless injectable contraceptive use is found to more than double the risk of HIV acquisition, reducing its use would not be likely to benefit public health.

The brief does emphasize that while evidence of a higher HIV acquisition risk remains inconclusive but suggests a link, women at high risk for HIV acquisition using progestogen-only injectable contraception be strongly advised to use condoms. It also says that messaging on the advisability of dual methods — condoms and highly effective contraception — to prevent sexually transmitted diseases and unintended pregnancies must improve.

The brief, which also addresses questions about the effect of hormonal contraception on women who are living with HIV (they can use all available hormonal contraception without concerns about disease progression, it says), concludes that the search for conclusive evidence of acquistion risk, as well as for safe, affordable technologies to prevent both unintended pregnancy and HIV acquisition continues.

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